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Stage 4

Stage 4 anal cancer means the cancer has spread to other parts of the body, such as the liver. The cancer can be any size and may or may not have spread to the lymph nodes. It is also called advanced anal cancer.

Diagram showing stage 4 anal cancer

TNM staging

Doctors also use another staging system for anal cancer called the TNM staging system. It stands for tumour, node and metastasis: 

  • T describes the size of the tumour
  • N describes whether there are any cancer cells in the lymph nodes
  • M describes whether the cancer has spread to a different part of the body

In the TNM staging system, stage 4 anal cancer is the same as any T, any N, M1.


The stage of your cancer helps your doctor to decide which treatment you need. Treatment also depends on:

  • your type of cancer (the type of cells the cancer started in)
  • where the cancer is
  • other health conditions

You might have one or more of the following treatments:

  • chemotherapy
  • radiotherapy 

The aim of treatment is to slow down the growth of the cancer. Treatment will also try to relieve any symptoms you have.

Other stages

Last reviewed: 
24 Apr 2019
  • AJCC Cancer Staging Manual (8th edition)
    M Amin and others 
    Springer, 2017.

  • Anal cancer: ESMO-ESSO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up
    R. Glynne-Jones and others
    Annals of Oncology 2014. Volume 25, Pages iii10-iii20